Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival

Mehaffey, J. Hunter; Haywood, Nathan; Hawkins, Robert B.; Kern, John A.; Teman, Nicholas R.; Krön, Irving L.; Yarboro, Leora T.; Ailawadi, Gorav

doi:10.1016/j.athoracsur.2018.02.041

Cited by 64 publications

(57 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several previous studies have shown increased preoperative risk/comorbidities and rate of postoperative complications in patients requiring permanent pacemaker after SAVR [23,24] . We found that pacemaker implantation reduces the risk of IHM after mechanical SAVR.…”

Section: Resultsmentioning

confidence: 96%

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Jiménez‐García¹,

Pérez-Farinós²,

Miguel-Díez³

et al. 2020

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

Objective: The aims of this study were to examine the incidence and in-hospital outcomes of surgical aortic valve replacement (SAVR) and to identify factors associated with in-hospital mortality (IHM) among patients according to the type of implanted valve used in SAVR. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2001-2015. We included patients who had SAVR listed as a procedure in their discharge report. Results: We identified 86,578 patients who underwent SAVR (52.78% mechanical and 47.22% bioprosthetic). Incidence of SAVR coding increased significantly from 11.95 cases per 100,000 inhabitants in 2001 to 17.92 in 2015 (P<0.001). Age and comorbidities increased over time (P<0.001). There was a significant increase in the frequency of concomitant coronary artery bypass grafting (CABG) and in the use of pacemaker implantation. The use of mechanical SAVR decreased and the use of bioprosthetic valves increased over time. IHM decreased over time (from 8.13% in 2001-05 to 5.39% in 2011-15). Patients who underwent mechanical SAVR had higher IHM than those who underwent bioprosthetic SAVR (7.44% vs. 6%; P<0.05). Higher IHM rates were associated with advanced age, female sex, comorbidities, concomitant CABG, and the use of mechanical SAVR (OR 1.67; 95% CI 1.57-1.77). Conclusion: The number of SAVRs performed in Spain has increased since 2001. The use of mechanical SAVR has decreased and the use of bioprosthetic valves has increased over time. IHM has decreased over time for both types of valves and despite a concomitant increase in age and comorbidities of patients during the same period.

show abstract

Section: Resultsmentioning

confidence: 96%

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Jiménez‐García¹,

Pérez-Farinós²,

Miguel-Díez³

et al. 2020

Braz J Cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…There was no significant difference in permanent pacemaker implantation (PPI) rates between the two valve types. However, the overall PPI rates of 8.22% were high compared to the expected rates following surgical aortic valve replacement, which is 1.9-2.7% (32)(33)(34)(35). Pacemaker implantation rate is an important performance indicator.…”

Section: Discussionmentioning

confidence: 99%

“…Pacemaker implantation rate is an important performance indicator. Patients who require PPI after aortic valve replacement have reduced risk-adjusted long-term survival compared those who do not require pacemaker implantation (35,36). Implantation technique has been shown to be an important factor that can impact pacemaker implantation rates, particularly with regards to the Perceval valve.…”

Section: Discussionmentioning

confidence: 99%

Sutureless valve and rapid deployment valves: a systematic review and meta-analysis of comparative studies

Flynn

Williams

Chakos

et al. 2020

Ann Cardiothorac Surg

View full text Add to dashboard Cite

Background: The treatment of aortic valve disease is the most common valvular surgery in industrialized nations, with 3-9% of the population over the age of eighty having at least moderate aortic stenosis. As transcatheter aortic valve replacement (TAVR) has become more established, newer surgical prostheses have been developed with a variety of anchoring systems that do not rely solely on sutures to hold the valve in an appropriate position. The Edwards Intuity valve is a bovine pericardial prosthesis that is modelled on the widely implanted Perimount MagnaEase aortic prosthesis. The Perceval valve is a bovine pericardial valve attached to a self-expanding nitinol stent, which uses the radial force exerted on the patient's aortic annulus and aortic root by the stent portion to hold the valve in position. This meta-analysis compares the outcomes of comparative studies of these two valve systems. Methods: This systematic review and meta-analysis compares the outcomes of rapid deployment valves (RDV) and sutureless valves (SURD) and was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations and guidance. The search strategy interrogated six electronic databases. Outcomes measured included all-cause mortality at latest follow up, stroke, cross-clamp and cardiopulmonary bypass (CPB) times, pacemaker implantation rates, paravalvular leak and post-operative transvalvular gradient. Results: The search strategy identified 407 unique papers for initial assessment with seven studies qualifying for inclusion in the analysis. The outcomes of 4,076 patients (1,650 RDV, 2,426 SURD) were included. There was no difference in mortality, stroke or moderate or worse paravalvular regurgitation between the two groups. SURD had significantly shorter CPB time by 15.7 minutes [95% confidence interval (CI): 4.2-27.1; P=0.007] and a shorter cross-clamp time by 11.3 minutes (95% CI: 6.3-16.3; P<0.001) compared to RDV. RDV had a lower post-operative transvalvular gradient by 2.5 mmHg (95% CI: 1.2-3.8; P<0.001) and a lower rate of mild paravalvular regurgitation (OR 2.51; 95% CI: 1.435-4.768; P=0.004). Conclusions: Both valve types have an adequate safety profile and are comparable to conventional sutured prostheses. There was a significant reduction in cross-clamp and CPB times associated with SURD. This may be of benefit for patients requiring multiple concomitant procedures and increases the utility of minimally invasive valve replacement. However, SURD was associated with higher post-operative transvalvular gradients and a higher incidence of paravalvular regurgitation.

show abstract

“…With the increase in the aging population and recent advances in surgical and transcatheter intervention, many patients who underwent permanent PM implantation had atrial fibrillation and a history of valve procedure. Conduction abnormality requiring permanent PM implantation are frequent and associated with an increased risk of heart failure-related hospitalization and lack of functional improvement and reverse remodeling after either transcatheter or surgical aortic valve implantation [19][20][21]. Data regarding the prognostic impact of PM implantation after valve intervention are somewhat controversial.…”

Section: Plos Onementioning

confidence: 99%

Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

et al. 2020

View full text Add to dashboard Cite

This study aimed to investigate the prevalence and clinical significance of lead-related tricuspid regurgitation (TR) in patients with permanent pacemaker (PM). A total of 2,533 patients who underwent permanent PM implantation between January 2008 and December 2017 in a single center were retrospectively reviewed. Among them, 429 patients who underwent transthoracic echocardiography within 90 days before implantation and were followed up at least 3 months after PM implantation were included. Patients who had pre-existing grade 3 or 4 TR, had a single atrial lead, or had undergone tricuspid valve surgery before PM implantation were excluded. Occurrence of PM-related TR (PMTR) was defined as worsening of TR by at least 2 grades on follow-up echocardiography. Cardiovascular outcomes were defined as the composite of cardiovascular death and hospitalization for heart failure. During the median follow-up of 855 days, 42 (9.8%) patients had PMTR and 86 (20.0%) presented with cardiovascular outcomes. In the multivariate logistic regression analysis, the presence of atrial fibrillation (hazard ratio [HR]: 2.07, 95% confidence interval [CI]: 1.27-4.09, p = 0.037]) and history of open-heart surgery (HR: 3.34, 95% CI: 1.68-6.68, p<0.001) were independently associated with PMTR. Patients with PMTR showed significantly higher cardiovascular events than those without (45.2 vs. 17.3%, log-rank p<0.001). Furthermore, PMTR was independently associated with the primary outcome (HR: 2.45, 95% CI: 1.43-4.22, p = 0.001). In conclusion, the occurrence of TR in patients with permanent PM is not uncommon. PMTR is associated with atrial fibrillation, the history of openheart surgery, and poorer cardiovascular outcomes.

show abstract

Need for Permanent Pacemaker After Surgical Aortic Valve Replacement Reduces Long-Term Survival

Cited by 64 publications

References 35 publications

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

National Trends in Utilization and In-Hospital Outcomes of Surgical Aortic Valve Replacements in Spain, 2001-2015

Sutureless valve and rapid deployment valves: a systematic review and meta-analysis of comparative studies

Prevalence, predictors, and prognosis of tricuspid regurgitation following permanent pacemaker implantation

Contact Info

Product

Resources

About